Reframing the experience of childbirth: Black doula communication strategies and client responses during delivery hospitalization

Doulas, or birth coaches, are said to be "changing the world, one birth at a time." Black doulas have been suggested to mitigate against lack of representation in obstetric care, limited identity acknowledgement and accommodation, and obstetric racism. However, scientific inquiry into the specific communication strategies and messages used by Black doulas to advocate for clients was non-existent in extant literature. Guided by the Agency-Identity Model, we analyzed 20 diary-interviews of nine Black doulas who recently served Black clients. Specifically, we explored Black doulas' communication strategies and whether these strategies had an impact on client agency. We found that Black doulas prepare their clients for patient-provider interactions, including conversations about certain medical treatments and procedures and the risks for Black women and birthing people, the importance of informed consent, how to be heard, and how to resist neglect or abuse. We found that, in turn, most Black clients were able to enact agentic responses. We describe the specific doula messages, and contextualize our findings, considering how these collective interpersonal communication strategies of Black doulas, and their clients' agentic transformations, may index a sociopolitical movement to reframe the experience of childbirth in America.

Utilizing Community-Centered Approaches to Address Black Maternal Mortality

The rise of Black maternal mortality rates throughout the country demonstrates a great need to utilize innovative frameworks to craft solutions that improve health outcomes for Black birthing people. Previous research and interventions have examined individual- and policy-level factors to reduce maternal mortality; however, these methods may lack a true community-centered approach to understanding the experiences of Black birthing people in local communities that have been disproportionately impacted. In addition, certain research methods may not recognize other marginalized intersectional identities (e.g., Black transgender men) who experience inequities in Black maternal health. This commentary aims to provide recommendations for utilizing community-centered strategies on Black maternal mortality informed by community-based participatory research principles.

Black women's experiences with professional accompaniment at prenatal appointments

U.S. public health statistics report dismal Black infant and maternal mortality rates. Prenatal care alone, while essential, does not reduce such disparities.

OBJECTIVES

The purpose of the study was to explore Black women's experiences when a perinatal support professional (PSP) accompanies them to prenatal medical appointments.

DESIGN

This research used a phenomenological approach, using data from in-depth individual interviews to explore the essence of 25 Black women's experiences.

RESULTS

We identified three major themes from the data that together, show that PSPs served as communication bridges for their clients. Clients said their PSPs helped them to understand and feel seen and heard by their medical providers during their prenatal appointments. The third theme was the deep level of trust the clients developed for their PSPs which made the first two themes possible. PSPs' intervention resulted in reduced stress and uncertainty in medical interactions and increased women's trust in their providers' recommendations.

CONCLUSIONS

Including a trusted, knowledgeable advocate like a PSP may be an important intervention in improving Black women's prenatal care experiences, reducing stress associated with medical interactions, and ultimately reducing pregnancy-related health disparities.

"We Experience What They Experience": Black Nurses' and Community Health Workers' Reflections on Providing Culturally Specific Perinatal Health Care

INTRODUCTION

Black perinatal health workers are part of a tradition of Black people fighting for the well-being of Black communities. The purpose of this article is to better understand the unique experiences of these professionals.

METHOD

Descriptive qualitative research was used to understand Black providers' experiences in a culturally specific perinatal public health program. A focus group was conducted with seven nurses and community health workers, and thematic analysis was used to analyze the data.

RESULTS

Three themes emerged: (a) shared lived experience and parallel process between staff and clients; (b) navigating multiple shifting gazes between clients, public health department, and medical systems; and (c) reproductive justice and community care characterize a culturally informed approach.

DISCUSSION

Findings revealed strengths and complexities facing Black nurses and community health workers in their roles. More work is needed in education, practice, and research to better prepare and support nurses and community health workers in culturally specific settings.

Adequate Prenatal Care: An Integrative Review

INTRODUCTION

Prenatal care (PNC) is a core element of preventive care and is vital in identifying and managing conditions that can put the pregnant person and the fetus at risk. National and international guidelines differ in what is considered adequate or quality PNC. Indices of care adequacy rely only on number of attended PNC visits without regard to factors that affect a patient's ability to obtain care or the quality of the care received. This integrative review explored stakeholders' perceptions of adequate and quality PNC.

METHODS

Three electronic databases, CINAHL, PubMed, and Web of Science, were searched to identify original research articles published between 2012 and April 2022. Studies conducted in the United States, published in a peer-reviewed journal, and having a primary focus on the components of adequate or quality PNC were included. The quality of included studies was assessed via the Quality Assessment Tool for Studies with Diverse Designs.

RESULTS

Thirteen articles met inclusion criteria. The concepts of adequate or quality PNC were not well defined in the literature. Studies revealed a variety of approaches to assessing individual components of PNC with at times conflicting results of what adequate or quality PNC is. Viewpoints regarding adequacy or quality of PNC were limited by the perceptions and interpretations of individual stakeholders, who included researchers, public health officials, insurers, health care providers, and patients.

DISCUSSION

Ideas of how to redesign PNC were affected by study setting and stakeholders, as well as the emergence and integration of telehealth into PNC delivery. This review is a first step in identifying the gap in the research literature regarding how these concepts are defined and measured. Future research is needed to identify the relevant components of PNC that are necessary to reach consensus definitions of both adequacy and quality of PNC.

Reproductive Justice, Public Black Feminism in Practice: A Reflection on Community-Based Participatory Research in Cincinnati

Research on reproductive justice has mainly, but not exclusively, appeared in academic literature in the context of grassroots social justice movements and as a theoretical framework for understanding the limitations of “reproductive choice” in the absence of social justice. But how can scholars design research to explore and understand reproductive (in)justice in the real lives of women of color? How can research partnerships between university scholars and community stewards be formed and sustained? What tensions and challenges are inherent in these efforts? And how can we find more equitable ways of sharing research findings and creating change with and not on behalf of our community? This paper reflects on the use of Community-Based Participatory Research (CBPR) in a reproductive justice research project focused on Black women residing in Cincinnati.

"I felt like it would've been perfect, if they hadn't been rushing": Black women's childbirth experiences with medical providers when accompanied by perinatal support professionals

AIMS

This study examined the nature and characteristics of Black women's interactions with medical providers during childbirth when accompanied by a perinatal support professional (PSP; similar to a doula).

DESIGN

The design was qualitative, and a phenomenological approach was employed to examine the meaning of women's experiences.

METHODS

We conducted in-depth interviews with 25 Black women enrolled in a perinatal support program in Cleveland, Ohio, in late 2017 and early 2018, exploring their interactions with medical providers, the meaning of their experiences, and the roles their PSPs played.

RESULTS

Clients broadly categorized experiences as positive or negative. When medical providers respected them, their birth plans and/or collaborated with PSPs, women reported more positive experiences. They associated negative experiences with providers having their own timelines and agendas, and women perceiving their needs were unheard and/or disrespected.

CONCLUSION

The findings emphasize the need for medical providers to be patient-centred, set aside assumptions, treat their patients as experts, value women's knowledge and voice, and treat patients and their supports as part of the team.

IMPACT

Findings support the importance of having a knowledgeable but non-medical support person present during birth. We discuss implications for how empowerment may be a tool to achieving better birth outcomes.

"We have this awesome organization where it was built by women for women like us": Supporting African American women through their pregnancies and beyond

Infant mortality is a problem that disproportionately affects infants of African American women, particularly residents in underserved neighborhoods. Chronic stress due to racism has been identified as an important factor in infant mortality. This study examined a novel community-based perinatal support professional (PSP) program, Birthing Beautiful Communities (BBC), in Cleveland, Ohio. BBC provides services for pregnant African American women in underserved neighborhoods with the goal of decreasing infant mortality and low birthweight rates by addressing chronic stress. Focus groups and one individual interview were conducted with the program's 14 PSPs, and 25 clients were interviewed individually. Interviews were analyzed inductively using qualitative thematic analysis to identify pervasive themes. Coders identified major themes of stress, resilience, community, cultural matching, advocacy, self-care, transformation, and self-actualization. BBC PSPs and clients alike reported the program is transforming the lives of clients by helping them address stressors. Findings suggest the community-based PSP model is an important but underused intervention in addressing infant mortality.